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Medical Claims Processing Specialist
2 months ago
Location: Tucson, AZ
Job Type: Full Time
Department: Behavioral Health
Division: BH BH UMC
Position Overview
As a Medical Claims Processing Specialist, you will be responsible for managing and evaluating medical claims for Pima County members. This role requires a keen eye for detail and the ability to navigate complex claims processes while ensuring compliance with applicable regulations and policies.
Key Responsibilities
- Review and validate medical claims documentation for accuracy and compliance with established guidelines.
- Investigate and resolve issues related to resubmitted or problematic claims in accordance with contractual agreements.
- Communicate effectively with medical providers and other stakeholders to address inquiries and provide necessary information.
- Conduct thorough pre- and post-payment reviews to ensure adherence to policies and procedures.
- Assist in the evaluation of new contractual guidelines to facilitate accurate and timely claims processing.
- Contribute to the development and refinement of operational procedures within the unit.
- Compile and analyze statistical data related to claims activity, preparing reports as needed.
- Process payments for medical claims while resolving discrepancies in compliance with relevant regulations.
- Interpret and input information from various source documents into the claims processing system.
Knowledge and Skills Required
Knowledge of:
- Healthcare regulations and standards applicable to medical claims processing.
- Medical coding systems including CPT, NDC, HCPCS, and ICD-10.
- Claims submission formats such as UB-04 and CMS 1500.
- Accounting principles relevant to claims processing.
- Effective communication techniques for both verbal and written interactions.
- Interpreting medical codes and terminology.
- Ensuring the accuracy and completeness of claims data.
- Conducting evaluations and making informed decisions.
- Utilizing automated systems for data entry and claims management.
Minimum Qualifications
- Three years of experience in medical claims processing or billing, or two years of experience with Pima County in a related capacity.
Preferred Qualifications
- Experience in claims/billing within a health plan or payer environment.
- Proficiency in billing healthcare claims and familiarity with the Arizona Healthcare Cost Containment System.
- Medical coding experience or certification.
Licenses and Certificates
A valid driver’s license is required. Candidates will undergo a background check as part of the hiring process.
Equal Employment Opportunity
Pima County Government is committed to fostering a diverse and inclusive workforce, ensuring equal opportunities for all candidates.
